Facing one of the toughest decisions in his life, Malik maintains agency, objectivity, and rationality by applying a decision-making process to guide his thinking.

Throughout life we face many important decisions. “Do I take this new job?” or “Should we purchase a house?”

To showcase how applying a decision-making process can help with these larger, critical decisions, we have created the following story where our fictitious hero Malik faces one of the biggest and most serious decisions of his life after being diagnosed with cancer.

As you join his journey, notice how a decision-making process helps Malik make more informed, less emotional decisions, and regain his sense of personal agency in a situation that initially left him feeling out of control. You will also see how the process can guide us to rethink values, gather more information, and predict outcomes.

We realize this is a serious decision we are detailing. But because we have received many questions about how to apply a decision-making process to health challenges, and because other people have shared their own personal stories of similar struggles, we worked with a team of experts to bring you the following. Remember that this example is fictional. It is not an attempt to provide medical advice.

When applying the decision-making process in your own life, keep in mind that the process is not linear. You may need to re-think your values, gather more information, or be more realistic about predicting outcomes in order to arrive at the optimal decision for you.

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Tough News; Tougher Decision

Malik is a 55-year-old man. He is married, with two children. During a routine doctor’s appointment, he complains about pain in his abdomen. After some tests, the doctor discovers that Malik has cancer. The cancer presents as a tumor, and the doctor advises Malik that it is important for him to decide on a treatment option soon. The doctor provides a few options that he believes will work well, and suggests that Malik consider them.

After his initial shock, Malik realizes he has a difficult decision to make in a short span of time. He needs to address the diagnosis head on, and hope that the tumor does not enlarge, or spread to his kidney or liver, something his doctor warned him about. Malik knows that this is a critical moment in his life. He decides to lean on the decision-making process to help him determine what to do.

First, he decides to figure out his decision frame.

Framing
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Framing His Decision

Malik considers his diagnosis. He feels helpless, frustrated, and wants to just ignore the tumor inside him. It’s much easier to contemplate going about his life like normal. But, Malik knows this is just wishful thinking. The doctor’s report made it clear that a choice must be made, and soon. For a few moments, Malik worries about how he will appear to others if he undergoes treatment. He also wonders how any recovery time will affect his family and how this will impact his work.

However, Malik quickly moves beyond this thinking. He realizes his thoughts have become unfocused, and that those factors are outside the frame of the decision he needs to make. He has cancer right now. The point is to stop the tumor’s growth, and make certain that the cancer does not spread to other parts of his body. His frame needs to be one of urgency—finding a treatment plan that is right for him, right now. That is his decision frame.

Revisit Decision Frame
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Outside Perspective

Malik wonders whether some outside perspective might be in order. Is his decision frame about determining a treatment plan too narrow? He calls a friend’s wife, who went through cancer herself five years before. She reminds him that though similar, their cancers are not the same. She says he is on the right path though. Focusing on what treatment to pursue, and not being distracted by concerns or considerations outside of that, is exactly the decision to concentrate on. 

Next, Malik thinks about his key values surrounding this decision.

Clarifying Values
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Clarifying Values

Malik has a number of values, and some that he lives his life by. While he knows that just thinking about values will not move his decision forward, it will shape the preferences he has for his options and the possible outcomes each may hold. He starts by writing down ten values that are core to his personality:

  •   Family
  •   Creativity
  •   Integrity
  •   Sense of adventure
  •   Faith
  •   Altruism
  •   Autonomy
  •   Personal development
  •   Compassion
  •   Influence

Malik decides it is important to trim his list to five values, focusing on those that will inform his preferences regarding the specific outcomes for this decision. He understands that he must focus on what he really feels is important and not what others may think he should find important. Now his list looks like this:

  •   Family
  •   Sense of Adventure
  •   Compassion
  •   Integrity
  •   Influence
Further Clarify Values
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Further Clarify Values

Malik realizes that Influence, or a sense of power, doesn’t really align with the preferences he’ll determine regarding a decision about how to treat cancer. Instead, he brings back one of the previous choices that makes more sense to him in this context—Autonomy. His updated list looks like this:

  •   Family
  •   Sense of Adventure
  •   Compassion
  •   Integrity
  •   Autonomy

Now Malik starts to generate treatment options by thinking about possibilities that his doctor mentioned.
Generating Options
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Generating Options

Malik is aware that when considering a cancer treatment, no option is going to seem truly attractive. And clearly, a medical professional will administer any of the doctor-recommended treatments, so each is “doable.” Malik is eager to discover just what paths to possible recovery are available for him. He will be able to choose which treatment option to pursue, and decide who should administer that treatment.

Malik realizes right away that doing nothing is not an option. If he were a much older individual, he might consider simply letting the cancer slowly grow, as sometimes the complications of treatment outweigh the benefits. But as a husband with a young family, he needs to think about his long-term health and future. Based on his doctor’s suggestions and the size of his tumor, Malik begins to think about four options: 

  • Surgery alone
  • Chemotherapy plus surgery
  • Radiation plus surgery
  • Immunotherapy plus surgery
 

Malik also is intrigued by the idea of alternative therapies. If there is something he can do to get rid of the cancer without the risks of these typical treatments, he’d rather do that. But he needs to learn more about this possibility.

Consider Alternative Therapies
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Consider Alternative Therapies

Malik talks to a different oncologist who is also an expert regarding alternative therapies. That doctor confirms his diagnosis, and tells him that though she is open to learning about outside therapies that are touted by some as a way to combat cancer, in her opinion there is not yet verified proof that therapies such as cannabis oil, an approach to diet, or cyanide from apricot pits actually helps fight cancer.

Malik’s independent research shows the same thing. He concludes that the science behind these ideas just isn’t there yet, and decides to shelve the idea of alternative therapies. 

At this point, it’s imperative that Malik takes the time to deeply research his options. But what does that mean, exactly?

Gathering Information
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Gathering Information

Malik knows that he needs to access recent information and studies about the different treatments for his cancer. He wants to tap into the knowledge of established organizations and hospitals for information, but also aims to compare what he learns to other data and opinions he finds from reputable online sources. He understands that one of the most important reasons for gathering information is to be able to predict outcomes. He wants his research to support that goal.

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Surgery

Malik learns that surgery alone is viable. This option would mean the physical extraction of the cancerous growth from his body. And because he currently has a single solid tumor, the procedure could be fairly straightforward.

However, it can take a long time to heal from such a large incision. There are risks of complications that come with any surgery, such as extra bleeding and infection. 

And, studies seem to indicate that the majority of patients who have surgery to remove this type of tumor will likely have to deal with the cancer coming back at some point in the future.

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Chemotherapy + Surgery

Malik learns that chemotherapy combined with surgery could be a solid option, as this treatment often effectively kills cancer cells. Drugs taken before surgery target cancer cells and hopefully shrink larger tumors, potentially making surgery less invasive. These drugs also work well against cancers that have spread in the body. Thankfully, Malik’s cancer has not spread—at least not yet.

A downside is that the treatment also kills healthy cells in the body. Some chemo drugs cause chemotherapy toxicity, which can cause long-term side effects, like heart or nerve damage. And there is also the risk that chemo causes delayed effects like a second cancer appearing in the body years later.

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Radiation + Surgery

Malik learns that radiation can also be combined with surgery. Radiation uses gamma or x-rays to kill cancer cells. Like chemotherapy, the goal is to shrink tumors, and radiation works best on a single tumor or mass, like Malik has.

Nevertheless, radiation also damages healthy cells in addition to cancer cells. The immediate side effects of radiation tend to be less severe than the side effects from chemotherapy.

It can take days or even weeks for radiation to start killing off cells, with some continuing to die off even months after the treatment has ended. That means that side effects in some slow-growing tissues might not show up until long after treatment is over. 

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Immunotherapy + Surgery

Malik keeps in mind that immunotherapy plus surgery is still another option. Immunotherapy uses drugs, treatment vaccines, or a person’s own strong immune cells to help their immune system fight cancer. Though this treatment works best against cancers that are small, it could still shrink his tumor over time. Thus, if surgery is still needed, it would be a far easier procedure. Immunotherapy uses drugs that don’t target cancer directly. Instead, they tell the immune system to fight the tumor as it would a virus in the body.

The downside is that this type of therapy can take time, and the cancer can continue to grow as the body works on a solution. There is also the risk that the immune system becomes so aggressive that it begins to attack healthy organs in the body like a person’s lungs, liver, or heart.

After conducting a lot of personal research, Malik feels like he understands the facts about his options pretty well.

Get a Second Opinion
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Another Opinion

In the back of his mind, Malik feels that a second opinion is in order. His second doctor confirms that Malik has an abdominal tumor, and outlines similar options as before. But, he also mentions that there are clinical trials associated with immunotherapy that might be worth further review.

After researching his options, Malik can think probabilistically about each, including the new immunotherapy option. But how should he make these projections? 

Predicting Outcomes
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Predicting Outcomes

Malik knows that there are no guaranteed outcomes when it comes to cancer.In every scenario, the primary goal is complete remission, where all signs and symptoms of cancer have disappeared, and Malik returns to his life as before. Beyond that, the hope is to avoid relapse, or the return of cancer symptoms. But there is a chance of relapse with all of these options.

With this in mind, Malik approaches this part of the decision-making process by charting out five steps.

1. Listing the possible outcomes for each option. 

2. Projecting likelihoods for possible outcomes in each option. These likelihoods are the approximate chances (out of 100%) that each outcome will occur. The percentages are the best estimates he can make, based on data he has reviewed from multiple sources about the type of abdominal tumor he has. Added together in the column, they must equal 100%.

3. Assigning impact for these outcomes in the form of points. Malik assigns the highest impact to the outcome he most wants to happen, which is remission. From there, the other outcomes are all things he’d rather avoid. But he wants to avoid some more than others.

4. Multiplying step two (the likelihood of each outcome) with step three (his assigned impact) to arrive at his expected impact, in the form of points.

5. Adding all the expected impact points to arrive at a Total for each option. Generally, a higher total should elicit stronger consideration as the option to pursue. From there, Malik can consider any remaining factors that might influence which option he ultimately chooses.

(Note: The likelihoods and assigned personal value for each option are fictionally presented for educational purposes only. Real-life scenarios involving cancer diagnoses would be different for every person and type of cancer.)

View His Four Options
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Taking Stock of His Situation

Malik has taken the time to project outcomes probabilistically. He is starting to get a sense about the choice he wants to make. He was able to quickly eliminate the option of surgery alone because the total expected value for that option fell far below his other options.

The scores for the other three options are similar. For Malik, surgery plus chemotherapy is now less appealing. The score for that option isn’t as high as the others, and even with a relatively low probability, Malik is concerned about possible long-term side effects such as heart or nerve damage, which he knows would conflict with his value for adventure and his ability to re-engage in his active lifestyle. Malik decides to pass on that option.

That leaves two options—surgery plus radiation (35.2 points), and surgery plus immunotherapy (34.1 points). Malik feels like he is in a bit of a bind. The two options have nearly identical total expected value. He thinks talking about his thought process and final options with his family and his doctor may help him crystallize his decision.

More Research
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More Research

While reviewing his notes, Malik is reminded that cancer cells sometimes survive and become resistant to radiation treatments. This can cause cancer to grow faster and be harder to kill. This has him leaning toward the surgery plus immunotherapy option. 

With his projected probabilities in hand, Malik is ready to speak with those close to him about this decision, to see if his ideas make sense. He wants to determine whether he may have overlooked some crucial information along the way, and wants to hear if his family raises  considerations he missed.

Explaining
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Explaining His Process

Malik has a good handle on the reality of his situation. He is able to speak with new authority about the possible merits and pitfalls of each option. He shares with his family how he decided between two final options. 

But, as Malik is describing his likely choice of surgery plus immunotherapy, he feels he may be missing a piece of the puzzle personally. 

His wife, knowing that Malik really values helping others, asks if his experience or treatment may also benefit others, and maybe even society at large. 

Malik decides he needs to re-visit an earlier part of the decision-making process.

Further Clarify Values
Generate More Options
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Further Clarify Values

Malik goes back to his values for inspiration. Last we looked, he had switched out the value of Influence, and replaced that with Autonomy in his top 5 values, thinking about how it is less important for him to appear powerful, and more important for him to feel powerful with his own choices. And now he realizes he wants to take that principle a step further. 

If possible, he wants to help society as a whole, rather than just himself. He replaces Autonomy on his list with Altruism. And that makes him think of another option.

He’d heard about clinical trials, where oncologists planned to test how well certain immunotherapy drugs helped patients both before and after cancer surgery. 

Malik knows the data compiled from such studies could help many people in the long run, so he decides to see if he would qualify for any of these trials.

After explaining his thought process, and revisiting other parts of the decision-making process, Malik has settled on the idea of a clinical trial combined with surgery. So, his course of action would be to take part in an immunotherapy clinical trial, and then have planned surgery at a later point in time. The hope is that his cancer will be reduced through the clinical trial treatments, making the surgery less invasive, while also providing data to help others.

Taking Action
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Generate More Options

Malik wants to determine if he’s been overlooking another treatment option. He reads about some clinical trials that will test how well certain immunotherapy drugs help patients both before and after cancer surgery. Malik gets excited thinking about participating in such a study. He knows that clinical trials like this can help shape treatment options for a large number of people.

That appeals to his values as well. He realizes that while he had recently replaced Influence with Autonomy in his list of top 5 values, he would rather help a larger section of society if possible. It is more important to him even than a sense that he has powerful control over his own choices. Malik switches out Autonomy for Altruism as one of his top values.

After explaining his thought process, and revisiting other parts of the decision-making process, Malik has settled on the idea of a clinical trial combined with surgery. So, his course of action would be to take part in an immunotherapy clinical trial, and then have planned surgery at a later point in time. The hope is that his cancer will be reduced through the clinical trial treatments, making the surgery less invasive, while also providing data to help others. 

Taking Action
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Taking Action

Malik discusses his plan with his doctor and his family. 

Together, they review clinical trials Malik might qualify for. Malik learns he would be a valid candidate for two of them and joins the one with an expedited timeline. 

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Action Accomplished

Malik finishes the trial, which involved taking drugs on an immunotherapy treatment plan. While the drugs didn’t help shrink his tumor, they did stall its growth. Malik then had surgery to remove the tumor. Afterwards, he was administered another type of immunotherapy drug to kill any remaining cancer around the surgery site, and to stave off any other cancer that might form while his body is healing from surgery and is most susceptible. 

This part of the process seems to be a success. Malik is currently in remission. 

Reflecting
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Reflecting

After healing, Malik spends some time reflecting on his decision-making process. He feels he was able to be honest with himself about his values, and that over time he determined the option he wanted to take, based on research and projected outcomes. He was able to explain to others why he had decided upon a particular option. 

Malik did feel it was a bit unlucky that the immunotherapy didn’t shrink his tumor before surgery. But, he isn’t about to let hindsight make him think he made the wrong decision. His process was solid. He does feel lucky that he did not have many minor ailments associated with either the surgery or the immunotherapy. And so far, he has not experienced large complications. That could change over time. 

But he knows he would still feel satisfied with his decision-making process. By following the process, Malik remained focused on the decision at hand, and handled his emotions. He also felt that he was managing the process and the decisions, instead of being a victim of his circumstances. He put in the work and made the best decision he could with the information he found, combined with his knowledge about his own values and preferences.

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Sources

Framing

To accurately focus on the decision at hand, start by framing what you are, and are not, making a decision about. Consider these three components as you build your decision frame:

  1. Purpose: What do you want to accomplish with this decision?
  2. Scope: Is your frame too narrow (doesn’t address the true issue at hand) or too broad (unfocused)?
  3. Perspective: How might others approach this decision?
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Clarifying Values

With your frame in mind, clarify how your core values influence your outcome preferences for this decision.

Keep in mind that values are personal, and can change over time. Also, what is most important to you in one decision may not be as significant in another scenario.

Often, one of your values will conflict with another. That’s why understanding your preferences is important. If you can’t pursue the option that would lead to your most valued outcome, knowing your second-best option will help guide your decision. Remember:

1. Be honest with yourself about your true priorities

2. Be clear about what matters to you (this will increase the likelihood you will be satisfied with your decision)

3. Your opinion about your own values is what matters

Click the Continue button to read about Malik’s work to clarify his values.

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Generating Options

In this phase of the process, we must work to develop multiple, appealing options. In the end, you can only select from among the options you have come up with, so it’s important not to limit yourself with an either/or point of view. Almost always, a third, fourth, or even fifth option will address more of your values.

Make sure:
1. They are under your control—you won’t rely on another person to execute the decision

2. They are significantly different from one another

3. They are attractive as an option

4. They are doable—the action following a decision can actually be accomplished

Click the Continue button to read about the options that Malik comes up with.

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Gathering Information

Gather more information on each of your options by tapping a variety of unbiased sources.

Make sure to go beyond sites you already visit, or people whose opinion you typically rely upon. Good information often comes from sources that are not linked to politics, specific companies, or pre-defined ideas.

Consider sources that are:

1. Credible and unbiased

2. Current and relevant (they have a meaningful impact on the decision at hand)

3. Realistic about their conclusions; they allow the possibility that they could be wrong

Click the Continue button to see what Malik discovers are some potential possibilities and pitfalls related to each of his options.

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Predicting Outcomes

In this part of the process, there are two main things you are predicting. First, you imagine all the things that can happen (outcomes), and how likely each outcome is. This you write down in percentages (out of 100%). 

Second, you determine how much you care about (value) each of those outcomes. This you write down in point values (on a scale of 100 points). For each option, multiply the percentages by the point values to determine expected satisfaction points for each outcome.

Add those values together for each outcome to get a total valuation for each option you are considering. Generally speaking, the higher your total, the more likely the outcome is to meet your preferences and expectations.

Click the Continue button to see how Malik chooses to handle thinking probabilistically about his options.

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Malik's Four Options

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Surgery

Possible Outcomes  

Likelihood (%)

Impact (Points)          

Expected Impact 

(Points)

No Remission

60%

0 points

0

Remission

15%

100

15

Remission + Health Complications/Pain

10%

50

5

Remission + Relapse

10%

20

2

Remission + Health Complications/Pain + Relapse

5%

10

.5

Total 

100%

 

22.5 points

Surgery + Chemotherapy

Possible Outcomes  

Likelihood (%)

Impact (Points)          

Expected Impact 

(Points)

No Remission

55%

0 points

0

Remission

20%

100

20

Remission + Health Complications/Pain

15%

50

7.5

Remission + Relapse

6%

20

1.2

Remission + Health Complications/Pain + Relapse

4%

10

.4

Total 

100%

 

29.1 points

Surgery + Radiation

Possible Outcomes  

Likelihood (%)

Impact (Points)          

Expected Impact 

(Points)

No Remission

50%

0 points

0

Remission

25%

100

25

Remission + Health Complications/Pain

18%

50

9

Remission + Relapse

5%

20

1

Remission + Health Complications/Pain + Relapse

2%

10

.2

Total 

100%

 

35.2 points

Surgery + Immunotherapy

Possible Outcomes  

Likelihood (%)

Impact (Points)          

Expected Impact 

(Points)

No Remission

50%

0 points

0

Remission

27%

100

27

Remission + Health Complications/Pain

10%

50

5

Remission + Relapse

8%

20

1.6

Remission + Health Complications/Pain + Relapse

5%

10

.5

Total 

100%

 

34.1 points

Explaining

Being able to express why you have arrived at a particular decision indicates that you have thought through the range of possibilities for each option and have actively chosen the option that best fits your values, while providing the greatest likelihood of success or happiness.

Explaining is a skill all its own. It forces you to think in ways that will either confirm your conviction, or change your mind if you are presented with compelling, but contradictory, information.

Click the Continue button to see what comes from Malik’s discussions with others.

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Taking Action

Acting on a decision means behaving in ways that align with your goal and values.

Create a plan that outlines the steps you must take to reach that goal. And then get going! You are committed, because you have clarified your values, gathered information, and predicted the possible outcomes necessary to move forward with confidence.

Click the Continue button to watch Malik in action.

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Reflecting

Once you have acted on your decision, step back and give yourself time to reflect on your use of the decision-making process.

Were you honest with yourself about your values? Did you generate enough valid options? Focus on the quality of the process, not the final outcome.

Why? Because, since luck is a part of life, sometimes good decisions lead to bad outcomes, or poor decisions result in a successful outcome.

Review each part of the process to figure out what you could fine-tune. Would you make the same decision again given what you now know?

Could you have known something that would have changed your decision? This post-decision analysis will strengthen your personal decision-making process and improve your future decisions.

Click the Continue button to see how Malik reflects on his decision-making process.

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